Provider Demographics
NPI:1417621541
Name:TISSER, SARAH (APRN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:TISSER
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 PINE ST
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4011
Mailing Address - Country:US
Mailing Address - Phone:818-263-0404
Mailing Address - Fax:
Practice Address - Street 1:645 LANDWEHR RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2309
Practice Address - Country:US
Practice Address - Phone:224-306-9464
Practice Address - Fax:224-306-9524
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360838102084P0800X, 261Q00000X, 2084P0800X
IL277003835363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health